Testimony FOI never got to hear

Last week the Freedom of Information Commission held a hearing on my request for SIM documents related to their Consumer Advisory Board’s (CAB’s) votes on appointments to SIM committees. Those committees are making very important decisions about CT’s $30 billion health care system and ethical questions have been raised about committee members receiving substantial SIM grants. I also asked for an opinion about CAB’s secret meetings to choose those representatives. SIM objected to submitting my prepared testimony so it was not allowed. Questions have been raised about the adequacy of SIM’s response to the FOI request. For example, their response included only one ballot from voting on the second round of candidates. If that had been the only vote cast, the outcome would have been different. There are seventeen CAB members and the FOI response included about a dozen ballots from voting on the first round of candidates.

CT still lags most states in Medicare hospital readmission rates

According to Kaiser Health News, ninety percent of CT’s acute care hospitals will be assessed a penalty by Medicare because of high readmission rates, starting October 1^st. 54% of US hospitals will be penalized this year for the percent of Medicare patients with certain conditions who return to the hospital within 30 days, down slightly from last year. As for last year, CT is second highest among states in the percent of hospitals facing penalties, behind only NJ. CT’s rate of penalized hospitals has changed little since last year, however the average penalty per hospital jumped from 0.22% last year to 0.66% of revenue this year. This year the highest penalty rate goes to Milford Hospital, followed by Middlesex and Johnson Memorial. Experts estimate that half of readmissions could be prevented by improving care including more clear discharge instructions, coordinating with community providers, and reducing complications during hospital stays. Other quality-based Medicare hospital bonuses and penalties will also begin in October.

New Gallup survey finds CT uninsured rate down more than half

Contrary to early CDC numbers, a new survey by Gallup finds that CT’s uninsured rate dropped from 12.3% in 2013 to 5.0% for the first half of this year. CT’s drop was similar to other states that chose to both expand Medicaid and create a state-based health insurance exchange. Rhode Island is tied with Oregon for the third biggest drop in uninsured rates among states, from 13.3% to 2.7%. An early CDC survey published in June found that CT’s uninsured rate had dropped very modestly from 9.1% in 2013 to 7.0% last year.

Advocates’ guide to underservice recommendations

Connecticut’s State Innovation Model (SIM) is seeking to radically transform our state’s $30 billion health system by aligning incentives to build value. SIM has chosen a shared savings payment model for those reforms. Advocates are concerned about incentives to deny necessary care under the new payment model, as happened in the past. SIM’s Equity and Access Council was charged with developing protections to limit and prevent underservice. The Council has offered its 72-page report with 28 recommendations. One critical recommendation was strongly supported by consumers, advocates, providers and at least one state agency. It was opposed only by insurers and consequently did not reach consensus. A guide to the report includes background on shared savings, its features and how it can impact underservice. The guide also includes brief summaries of the Council’s recommendations, as well as the original report text. We expect the report to be opened for public comment soon.

August web quiz on family caregiving in Connecticut

Test your knowledge of family caregiving in Connecticut. Take the August CT Health Policy Webquiz.

Advocates’ guide to underservice recommendations

SIM is seeking to radically transform our state’s $30 billion health system and has chosen a shared savings payment model for those reforms. Advocates are concerned about incentives to deny necessary care under the new payment model, as happened in the past. SIM’s Equity and Access Council was charged with developing protections to limit and prevent underservice. In June, the Council published its 72-page report with 28 recommendations to prevent, monitor and fix underservice in the new system. All but one recommendation reached consensus among the independent consumers, insurers, providers and state agencies on the Council. We’ve published a guide to the recommendations for busy consumer advocates. We expect the report to be opened for public comment soon.

The single controversial underservice recommendation was only opposed by insurers while strongly supported by consumers, providers and at least one state agency. Without this provision, all the savings (both halves) generated by underservice would default to the insurer giving them twice the incentive for underservice. Insurers have several tools to encourage underservice that often result in denials of necessary care, including prior authorization and formularies. Since insurers will know which metrics are being monitored for underservice, but ACOs will not, insurers are potentially both in a position to engineer underservice and to double their profits from it.  The lack of this protection not only undermines the original SIM commitment to deny savings for underservice, it also increases the risk of people being denied necessary care, and reduces badly needed resources to build value in health care – a main SIM goal. 

CT health reform progress down again

Unfortunately CT’s progress toward health reform dropped again this month to 26.4.5% this month, adding to last month’s dip. News that the only about half of AccessHealthCT consumers are even using the coverage they pay dearly for, increasing concerns about SIM’s ethics and grants to insiders, SIM’s cool reception to consumer protections in risky financial models, transparency issues and budget cuts all contributed to the decline. Only Medicaid offered bright spots this month including a sharp reduction in phone wait times and a continued commitment to strong stakeholder engagement in reform planning. The CT health reform progress meter is part of the CT Health Reform Dashboard.